Trying to change pumps Medtronic 730 to tslim

Diabetes Technology
1

I was diagnosed in 1996 with a BS 463 fasting. I have been pumping off and on for close to 10 years. 1st with the Omipod, that didn’t work well for me as I kept knocking it loose. I then went to a 530G that was covered by Medicare. It was replaced a 630 and the Warranty expired in July 2020.
I have been very frustrated with my inability to order Medtronic supplies in a timely manner. I have been without supplies for just under 3 months in 20. So, I looked into the T-slim and requested Tadem to help me make the switch. The Tadem folks tell me that I do not qualify for a insulin pump under Medicare rules. That it is impossible that I have a pump and that I am receiving supplies under Medicare or CGM supplies. Medtronic om the other hand wants to upgrade me to a 770 pump. I am using the 630 as a brick or just a pump as I am using G6 and right now the Med pumps do not communicate with the G6. And I have tried and rejected the Medtronic CGM as the readings were off by over 100 points vrs finger sticks. Once it was off over 300 points. And if I had allowed the Dr to change the settings, well life might have been a bit too intense. I was already running low which the meter demonstrated

I have been waiting for return calls from Tadem for close to 4 months both from the sales office and the local rep. I dont really want to lock myself into another Medtronic pump that doesn’t talk to the Dexcom. So I have a few questions;

  1. I would greatly prefer to keep my G6 and find a pump that can use the information that the CGM provides.
  2. Is this how Tadem responds to customers requests?
  3. Is there another pump supplier that perhaps I am not aware of or one that may be introduced shortly that works with the Dexcom?
2

I’m sure another Medicare person will give you a more detailed answer, but I’m pretty sure the problem is that merely being out of warranty doesn’t qualify you for a new pump. There needs to be “medical necessity” for a new pump. But honestly, it can be something little… Like you’ve got a crack in the plastic, the screen is too dim, etc…

And no, usually Tandem people are incredible, but I guess there’s a weak link every once in a while. They are kinda swamped with people flocking from Metronic, though. Growing pains. I’ve seen many complaints about the prices moving along very slow. Please just keep trying. It might be beneficial to you too speak to a regional rep, rather than a random in the call tree.

3

Was this the end of 5 years? Medicare considers first year a rental, then 4 years warranty.

4

Yes, this is after 5 years 4 months. With Medtronic. As I said originally Medtronic is more than willing to move forward with a 770 or 780 model, but Tadem tells me that Medicare would / could not be covering my CGM nor pump supplies. They wouldn’t say why, but Medicare has been covering both for the past 10 years. So is there a different requirement when moving from 1 company to the other?
The 2 problems with Medtronic is the supplies always seen to be missing a required form or the are in short supply. And of course it doesn’t work with Dexcom.

5

Could be specific to your medicare provider? For example UHC has traditionally only covered Medtronic, but recently started covering Tandem for employer plans. I’m not on medicare yet, but understand MC Advantage plan may have specific rules not consistent with MC.

Hopefully just someone with old knowledge, and you get it cleared up.

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6

My insurance covers only tandem or Medtronic.
That’s it. So maybe Medicare only has contracted with Medtronic.
I never had an issue with supplies on Medtronic. But the sensors were a waste of time.
Maybe contact one of the online pharmacies who do all the Medicare billing and know how to navigate it all

7

Byron,

I suspect you might be discussing the Medtronic 630g. If so (I am just speculating here) but since you are on Medicare the pump warranty is actually five years, not four. Its complicated, but the medicare pump warranty on all pumps is five years. Given that your pump likely will not be out of warranty until at least October 2021 and more likely sometime in 2022.

Given where the T-slim are at these days, they are not routinely calling Medtronic 600 series pump users with medicare back.

Again just a guess.

I am a Medtronic ambassador. My opinions are my own. They did not pay me to say nice things. OK, they sent me a shirt and a cup but even I am more expensive than that.

8

Rphil2, This is not the issue, I have had my existing pump for 5 years and 4 months. Acording to Medtronic i was eligible for a updated pump on July 1st. IF it was for the supply chain and sensor issues I would have accepted their upgrade offer, but like I said in my original note I have been without pumping supplies all of December and January as well as 2 weeks in June. In fact I used my last insertion supplies 2 days ago and the recent order was delayed yet again for 2 more days. At least it has been shipped this time. So I have been on 6 to 8 shots a day for the last 30 hours or so. I only have Novlog, no longer acting insulin at this time.

Tim, it is not an issue that Medicare only covers one or the other pump. Unlike United Healthcare, they cover either. The issue is that Tadem looks at my age and declare that I wasn’t on Medicare 10 years ago, so I’m not covered. Couldn’t be covered, as I am only 68. I was disabled after being struck by a car, WHILE walking, tossed about 125 feet acording to the police broke lots of bones and was forced on Medicare after 2 years after going on Disability. I would have preferred to stay on my company’s Healthcare plan, but I was forced onto Medicare, 8 years early. Medicare supplied both the 530 and 630G pumps, as well as my G6. My company’s plan covered the POD.

9

You certainly have a unique situation. I suggest you contact Tandem again, and ask to speak with insurance expert, not just sales/customer support.

I recently got Tandem pump, not on medicare. But my plan required c-peptide test, which is typically a medicare requirement. Despite the fact that I was diagnosed at age 5 as Type 1, they still required it. Anyway, I was able to talk with Tandem rep that was familiar with the nuances of insurance plans specific to my state and plan.

(P.S. Yes, my c-peptide test confirmed that after 55 years, I still don’t make insulin).

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10

@Byron:

I am certainly not a Medicare expert … I’m simply an old guy that tries to get the best care that I can under complex and convoluted rules. Also, I’m still on my first Medicare-provided pump … which happens to be a Tandem. Even though I have had it for 5 years and 8 months, I’ve not yet considered replacing it.

It seems a lot easier to find out Medicare’s requirements for initially covering a pump than it is for replacing one. Thus far, this is the best reference that I can find:

https://www.medicareinteractive.org/get-answers/medicare-covered-services/durable-medical-equipment-dme/replacing-dme

This certainly agrees with @Robyn_H that 5 years is a necessary, but not sufficient, condition for getting a replacement pump. Also, it seems clear that arguing for CGM-integration and other new-and-improved features is NOT the tack to take in dealing with Medicare. The primary argument to Medicare, it would seem, is that this is a like-for-like replacement. But, I expect that there ARE people who are adept at framing things like this in a way that is acceptable to Medicare.

If I were facing this. I think that this is how I would proceed:

First, I would try to contact the “Medicare wizard” at your endo’s office … who probably works in the insurance office rather than in the actual clinic … to see what experience and suggestions they have. It seems unlikely that this is the first time that they have been down this road. I expect that the prescription for a new pump will have to be very carefully crafted to pass Medicare’s requirements.

Next, I would craft a very nicely worded letter to Tandem’s CEO explaining your special circumstances and why you want to replace your Medtronic pump with a Tandem (you can tell him about G6 integration, software upgrades, etc). You should conclude by asking him to forward this to the best person on his staff who could help you to negotiate the challenges of Medicare. I would suggest that there is no added value telling him that you have spent XXX days/weeks trying to get an answer from Tandem.

Note: in looking at the Tandem leadership page, it is not obvious which of their VPs and EVPs is actually in charge of interfacing with insurance and/or Medicare … that I why I suggest writing to the CEO.

In my experience (and I’ve only contacted a CEO a couple of times), you should soon get a phone call or email from someone at Tandem who starts with: “Hi, this is Director of Insurance Coverage Bob Jones at Tandem. Our CEO has asked me to reach out to you. How can I help?”

I wish you the best because, at some level, I think that you will have to “thread the needle” to get Medicare to cover a replacement pump at this time.

At least that is what I see from my clearly non-professional perspective.

John

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11

My understanding is that Medicare doesn’t cover due to just being out of warranty, which you have met. MC also requires that current pump is not working or compromised somehow. For example sticky or hard to press buttons that lead to mis-dosing, or scratchy screen hard to read, leading to mistakes in dosing, etc.
But those are questions Tandem rep should be asking to support your need for new pump. Might be able to claim CIQ is required due to Medtronic pump failing to suspend/change basal and you have frequent lows.

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12

If you are on Medicare, Tandem will not be the one supplying your pump. You will use a Medicare supplier. This link is from Dexcom but most or all of these suppliers also supply Tandem pumps. I use Solara for both my Dexcom G6 and Tandem supplies and will use them to purchase my next Tandem pump in December. If I were starting from scratch, I would use US Med because they supply 3 months of Dexcom G6 supplies at a time. I assume that they also provide Tandem supplies. When I started with Medicare I used CCS Medical and they were very competent. I don’t love Solara but they are okay.

Since the 630G was not released until August 2016, I think that you are mistaken that you have had the pump for 5 years. https://diatribe.org/fda-approves-medtronic-minimed-630g-system

13

Per this in original post:
“I then went to a 530G that was covered by Medicare. It was replaced a 630 and the Warranty expired in July 2020”.

I think original pump 5 years ago was 530, under Medicare coverage. Then due to pump failure or Medtronic offer, was replaced/upgraded to 630, for remaining portion of 5 year period. As a replacement, I think “warranty” keeps original MC purchase date.

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14

That makes sense. I think that the original poster then needs to work with a supply company to get on the road to getting a Tandem.

I dread going through my first pump purchase with Medicare since I know it will probably take forever.

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Byron, I hope my experience can help you here. All the Medicare pump suppliers mess up. I have had all three as suppliers in my area, and each one of them has screwed up differently. I have right now Solara, and they do relatively well when it comes to keeping up with the pump supplies. Here’s what I have done to get my pump supplies needs met: 1. Get the name of the pump salesperson for your area. They have a vested interest in getting you what you need and will follow up better than anyone else. 2. Send correspondence, so you have everything in writing. Make sure to keep a copy for yourself of whatever you send. 3. I find that with all the companies that leaving a message does no good. 4. When I need some info from Medicare, I email them around 1 a.m. I have a reply usually within two hours. 5. Enlist the help of your doctor’s office, especially if someone handles only prescriptions and items like that. You may also want to talk to the person in the doctors office who does the insurance; they probably know the rules and regs better than anyone. 6. As a Tandem customer, they will check on your need for supplies for the pump every three months. 7. The integrated CGM for Tandem you can get from the same supplier, and that is monthly, but here’s where I have found that there have been challenges. 8. This was a pretty sharp action I took but it got me movement. When I was getting my supplies directly from Dexcom for the CGM, I went without any sensors for over a week. I got the main number for corporate, looked up who was over customer service and called that number every day and left a message saying that it was obvious they cared more about profits than the health of people till I got the supplies. And that is the message I left on the head of Customer Services phone every day.

I also got a call from a person who reports directly to that person in charge, who gave me her information in case I had any other issues.

I find almost every issue that I’ve had with any of the companies has to do with the insurance companies. It often seems to me that the primary function is to make money for the insurance company while secondarily serving their customers. Why do we actually need an intermediary between us and the supplier of a product? If we had, as many countries do, a single payer system, customer wouldn’t have to nag at third parties who have to justify their existence.

I recently was asked by my CPAP supplier if I used a diabetic supplier. Apparently they must have gotten a Medicare contract and will be sending CGM and pump supplies. That company is verus healthcare, although I don’t know if they are nationwide. I’m inclined to use their service once I get contact from them regarding my needs.

Another place where you might be running into issues is that no one in the doctors office is following up from their end. Every time you change anything diabetic related, you probably need a new RX for it. Unfortunately, if you don’t have a dedicated person at a company working with you, then you can get lost in a crowd of hundreds of low-paid, don’t really care customer service people.

When I have issues - and I have lots because I’m on lots of meds, including a controlled substance - i have escalated to corporate. I now have someone I call at Wellcare Insurance who takes my calls about whatever new problem I have. I asked him to listen to every single call I had made to the company in the last six months before I contacted him. It was hours of listening dis-pleasure. He learned alot and passed it on to the corporate team.

I’m not interested in how people or organizations mess up, it’s how they fix it that matters to me.

I hope some of this information helps. Good luck!

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16

I went from a Medtronic pump, also of a few months over 5 years old, to a Tandem, just a few months ago, with Medicare. I originally contacted Tandem online, got a call within a couple days, if I remember correctly, and the rep who called was very helpful. We discussed the condition of the old pump, and a button sometimes sticking seemed reason enough to replace it. He gave me a choice of vendors, and I figured staying with CCS Medical, which had been supplying my MM supplies, would be quickest, though I may have been wrong about that. The fact that I was getting G6 supplies from Dexcom might have been part of the confusion. CCS did call me the following day to set it up, but said I had to wait till my old supplies were finished before the new pump and supplies could be sent, that everything would be bundled for 90 day shipments. Hah! I got an initial nicely bundled 90-day shipment of pump stuff plus dexcom stuff, but, for the second shipment, they sent 90 days of pump supplies, but just 30 days of dexcom. CCS is insisting that is the only way they can do it with Medicare. So, 8 extra shipments a year to keep track of, and 8 extra times something can go wrong.

I often get frustrated with Tandem Control IQ issues (I’ve already eaten, don’t shut off the basal! Gonna need that insulin by the time it is actually affecting me! or, I wasn’t correcting that yet because I was just going to exercise, but you just bolused! or, That’s not a low coming, I was lying on my sensor and it went low, and the reading is just coming back to normal quickly – that didn’t require a bolus!), but, after 65 years of taking insulin, I am slower than average to react to it, and also slower to digest even glucose, so that bolus before exercise, for instance, is probably more of a problem for me. But, wow, 90%+ time in range is not something I’m going to complain about.

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17

I do love my Medtronic 670g and I ma especially looking forward to the new 770 (just approved by the FDA) and the 780g in late 2021 or early 2022. These are expected to be software updates.

Medtronic has released a very attractive deal for customers who do not have insurance for the sensor. If you have interest of staying with Medtronic I suggest you look into it before you chose to change.

rick

Now for my customary disclosure.

I am a Medtronic ambassador. My opinions are my own. They did not pay me to say nice things. OK, they sent me a shirt and a cup but even I am more expensive than that.

18

Thanks for the suggestions. I have tried most of them, including mailing problems directly to VP of pump supplies. That worked the 1st time, but not the 2nd or 3rd times. Seems that a new person took over the position…

19

I suspect that you are correct in the dates, things that happened yesterday seem to disappear, once the issues are carried for. Either way Medtronic is the company telling me that the Warranty coverage ended in July. It seems that there is an open recall on the 630 pump. And the retainer insert broke on my pump last weekend. The support folks were great and got out a replacement pump the next day. To bad the supply side doesn’t work as smoothly. It might be different if they could at least one order out without having to write a dozen or so letters and phone calls. The CGM and CAPA supplies are also from a Medicare approved supplier and they always seem to be able to ship supplies quickly and on time. It seems to me that my initial problems started when I dropped the Medtronic sensor and moved to Dexcom. And the supply issues have continued. It isn’t that I dislike Medtronic, but I dislike wasting hours every three months trying to get supplies… Not sure if Tadem will be any better, or do I wait for the other two suppliers to come to the market, they say 2021, but it’s more likely 2022 or later. And even at that I am relatively sure that they will have start up issues as well.

20

Perfect! You qualify for new pump uunder Medicare.

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